As someone who is relatively new in learning about pressure ulcers I was absolutely staggered by the cost to the NHS. £1.4-£2.2 billion a year, or £3.8 million a day. Clearly it has now become imperative that health and social care providers take the appropriate steps to prevent avoidable pressure ulcers and manage unavoidable ones.
While this top-level view is something for the industry to tackle, I would like to consider a more personal experience. My grandmother. She is 92, with advanced dementia and poor mobility. She is susceptible to pressure ulcers, particularly in her legs.
As a first remedy, the care home she now lives in wanted to focus on her diet. Most importantly, it was explained to her next of kin (my father and uncle) that she needs to improve her hydration throughout the day. Unfortunately, as a 92-year-old woman, my grandmother’s idea of hydration is drinking 11 cups of sugary tea a day, with a chocolate digestive to wash it down. Trying to get her to drink water in sufficient amounts is something that is not only confusing for her, but a huge challenge for everyone involved.
Moving on from hydration, her doctors and carers have encouraged her to move/walk as much as possible through the day. Again, a complicated task for someone who has had dozens of falls over the past 5 years, some resulting in prolonged stays at the Royal Free Hospital, in London. During the night, carers have also made an effort to reposition her, in order to not put too much pressure on her legs. Again, a tricky task for someone who could sleep through an earthquake without too much trouble.
As someone, who is not considered next of kin but who does consider their grandmother to be their hero, its an extremely difficult thing to witness. The opportunity to work on our Implementing NICE Quality Standards ‘Pressure Ulcers’ has helped me understand and appreciate the incredible work that the NHS and care homes do to help victims of pressure ulcers.
However, one question still troubles me: where do you draw the line between quality of care vs quality of life? For example, is it right to re-position a woman who finds peace at night having been confused for the majority of the day? Similarly, should she be consulted about her care or will this confuse her further and subsequently her treatment? Should my father and uncle be more involved in her treatment? Or will their emotion prevent logical care of an elderly woman towards the end of her life.
On average nearly 2,000 pressure ulcers are newly acquired each month with over 700,000 people affected each year. Clearly the goal for the NHS is to reach a stage where pressure ulcers are preventable. Not just to reduce the eye-watering cost it has on our economy but also so that people like my grandmother can have the best quality of life possible. While this may be some way off, hospitals and care homes have the responsibility to better manage pressure ulcers, taking difficult decisions that can have a drastic impact on both the victim and their next of kin. Importantly, by considering whether their aim is to improve quality of life or quality of care.
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